Journal of Diabetes Investigation · Published 2026-05-07 · DOI 10.1111/jdi.70324
ABSTRACT Aims/Introduction People with diabetes exhibit early‐stage cardiovascular disease (CVD). In this study, we developed a new diagnostic algorithm to predict all‐cause mortality and CVD using both the ankle‐brachial index (ABI) and brachial‐ankle pulse wave velocity (baPWV) in individuals with diabetes. Materials and Methods This study utilized data from the Kyushu Prevention Study for Atherosclerosis, a prospective, multicenter survey. A total of 3,933 participants with diabetes were followed. The primary outcomes were all‐cause mortality and CVD. Risk was categorized based on ABI and baPWV, and the prognostic differences were evaluated. Additionally, the independence of this classification from the Framingham Risk Score (FRS) was tested. Results ABI was the strongest predictor of all‐cause mortality. Individuals with a low ABI (<0.70) had the highest risk, while those with an intermediate ABI (0.70–1.0) exhibited a risk similar to individuals with the extremely high baPWV (≥24 m/s), forming the second highest‐risk group. For coronary heart disease, ABI and baPWV had complementary predictive value. Individuals with a low ABI (<1.0) or high baPWV (≥19 m/s) were at the highest risk, whereas those with a low baPWV (<14 m/s) had the lowest risk. For cerebrovascular disease, only baPWV was a significant predictor, with risk cutoffs above 23 m/s and below 14 m/s. Conclusions We developed a new diagnostic algorithm incorporating both ABI and baPWV to predict all‐cause mortality and CVD in individuals with diabetes. This algorithm improved the accuracy of mortality and CVD risk assessment and was independent from the FRS.
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